Strabismus after balanced medial plus lateral wall versus lateral wall only orbital decompression for dysthyroid orbitopathy.

PURPOSE: This study aimed to determine the relative incidence and time course of new-onset strabismus after balanced medial plus lateral wall orbital decompression versus decompression of the lateral wall alone for dysthyroid orbitopathy. METHODS: The study design was a retrospective nonrandomized comparative case series. Thirty-two consecutive patients underwent balanced medial plus lateral wall orbital decompression or lateral wall orbital decompression for dysthyroid orbitopathy. The incidence, duration, and treatment of postoperative strabismus was recorded for each patient. RESULTS: Significant preoperative strabismus was present in 31% (4/13 patients) of the balanced decompression group and in 26% (5/19 patients) of the lateral wall decompression group. Only 25% (1/4) of cases of preexisting strabismus in the balanced decompression group resolved postoperatively without muscle surgery, whereas 60% (3/5) of cases in the lateral wall decompression group resolved postoperatively without surgery. Preoperative strabismus was absent in 69% (9/13) of patients in the balanced decompression group and in 74% (14/19) of patients in the lateral wall decompression group. New-onset, persistent postoperative strabismus developed in 33% (3/9) of patients in the balanced decompression group and in 7% (1/14) of patients in the lateral wall decompression group. CONCLUSION: Lateral wall orbital decompression may produce less new-onset, persistent postoperative strabismus than balanced medial plus lateral wall orbital decompression for dysthyroid orbitopathy.

Use of apically based periosteal flaps as globe tethers in severe paretic strabismus.

OBJECTIVE: To evaluate the technique of using an intact autogenous periosteal flap for tethering of the globe in patients with severe paretic strabismus. METHODS: We performed a periosteal flap procedure on 5 patients and followed their postoperative course. The flap was created from the medial, lateral, or superior orbital walls. A description of the harvesting and manipulation of the flap and the initial postoperative findings are presented. RESULTS: All patients showed marked reduction in their postoperative strabismic deviation compared with preoperative measurements. Greater early postoperative swelling was noted after this procedure than with the standard strabismus surgery. No complications were experienced during or after surgery. Two patients required a second operation for adjustment of the periosteal flap for adequate alignment. CONCLUSIONS: The vascularized periosteal flap technique provides an excellent tether for the globe. Early and late stability has been favorable.

Selective B-wave reduction with congenital cataract in neurofibromatosis-2.

OBJECTIVE: To electroretinographically evaluate a case of neurofibromatosis-2 (NF-2). DESIGN: Case report and literature review. PARTICIPANT: A 29-year-old man diagnosed with NF-2. MAIN OUTCOME MEASURES: Electroretinography (ERG), ophthalmic biomicroscopy, and ultrasound examination results were reviewed. RESULTS: The ERG of one eye showed selective reduction of b-wave amplitudes. A characteristic posterior subcapsular lens opacity also was observed in that eye. A dense white congenital cataract and a retinal detachment were detected in the fellow eye. CONCLUSIONS: An inner retinal dysfunction, as evidenced by an abnormal ERG, may occur in NF-2. Further ERG evaluation of other patients with NF-2 is indicated to determine possible associations between NF-2 and selective b-wave reduction.

Intraocular pressure change after sutureless phacoemulsification and foldable posterior chamber lens implantation.

PURPOSE: To investigate the effect on intraocular pressure (IOP) of sutureless scleral and corneal tunnel Kelman phacoemulsification (KPE) with foldable posterior chamber intraocular lens (IOL) implantation. SETTING: Jules Stein Eye Institute, Los Angeles, California, USA. METHODS: Preoperative and postoperative (1 and 6 weeks and 6 to 8 months) IOP measurements of 385 consecutive eyes having uneventful phacoemulsification and foldable posterior chamber IOL implantation were reviewed retrospectively. A subset of 193 eyes for which no IOP measurements were missing at any follow-up were analyzed separately. RESULTS: Mean preoperative IOP was 15.8 mm Hg +/- 0.2 (+/- SE). It dropped postoperatively by 1.3 +/- 0.2 mm Hg at 1 week (P < .001), 2.5 +/- 0.2 mm Hg at 6 weeks (P < .001), and 2.2 +/- 0.2 mm Hg at 6 to 8 months (P < .001). Mean preoperative IOP for the subset without missing data was 16.0 +/- 0.3 mm Hg. It decreased by 1.1 +/- 0.3 mm Hg at 1 week (P < .001), 2.3 +/- 0.2 mm Hg at 6 weeks (P < .001), and 2.2 +/- 0.2 mm Hg at 6 to 8 months (P < .001). Wound construction (scleral versus corneal tunnel), anesthesia type (topical versus posterior orbital injection), the eye operated on, and patient age and sex did not significantly influence the postoperative pressure change. Patients with a preoperative diagnosis of glaucoma had significantly higher 1 week postoperative IOPs; however, the differences were statistically insignificant at 6 weeks and 6 to 8 months. CONCLUSION: Sutureless KPE with foldable posterior chamber IOL implantation lowered IOP by 1.1 to 2.5 mm Hg for the 6 months immediately following surgery. Glaucoma patients had a statistically significant initial rise in IOP at 1 week.

Benign mixed tumor arising from an accessory lacrimal gland of Wolfring.

We report a 59-year-old man who had a slowly enlarging mass of the central upper eyelid that proved histopathologically to be a benign mixed tumor (pleomorphic adenoma) arising from an accessory lacrimal gland of Wolfring. The tumor was totally separate from the main lacrimal gland, and its deep location in the lid excluded origin from dermal sweat glands. Benign mixed tumors of the accessory lacrimal glands are exceedingly rare tumors of the ocular adnexa.